The bi-articular hip prosthesis for fractures of the femoral neck-a preliminary report
ABSTRACT The bi-articular hip prosthesis (BHP), based on an original design by Bateman, is a bi-polar hemi-arthroplasty which seeks to reduce acetabular wear. We have used this prosthesis to treat 101 elderly patients with displaced intra-capsular fractures of the neck of the femur. The results of the first two years experience with this prosthesis are encouraging. Post-operative hip pain was not significant and did not interfere with mobility. The use of the antero-lateral approach to the hip joint prevented dislocation of the prosthesis, in contra-distinction to reports of series in which the Southern approach was used.
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ABSTRACT: We report a series of 640 consecutive cervical hip fractures which were followed prospectively for two years after primary internal fixation with two hook-pins. Secondary arthroplasties were performed as salvage procedures in 75 cases and the early outcome of these was studied retrospectively. The mean time in hospital was 25 days for prosthetic replacement, though 60% of the patients had other medical conditions considered as risk factors. Mortality was 5% after six months and 8% after one year. Dislocation was seen in 11% and additional surgery was required in 4%. There was one case of deep infection and one supracondylar femoral fracture. In some cases there was considerable delay between the primary and secondary operation due to lack of awareness of functional deterioration, but although many patients had poor mobility before the secondary operation this was greatly improved within six weeks of the arthroplasty. We conclude that elective secondary hip arthroplasty for failure of fracture fixation is a safe and successful procedure. Once the decision to perform an arthroplasty is taken, this should be done without delay to avoid deterioration of function.The Bone & Joint Journal 12/1989; 71(5):777-81. · 2.80 Impact Factor
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ABSTRACT: Dislocation of bipolar hemiarthroplasty of the hip is a rare complication. The objectives of our study were to assess the incidence, contributing factors, and outcomes of bipolar prosthesis dislocation. From 1974 to 2001, 1812 primary bipolar hemiarthroplasties were done at our institution. Seventy-four percent were done in patients with fractures of the femoral neck. An anterolateral surgical approach was used in 79% of hips, a posterolateral approach was used in 14% of hips, and a transtrochanteric approach was used in 7% of hips. Thirty-two hips dislocated. The cumulative probabilities of dislocation at 1 year, 5 years, 10 years, and 20 years were 1.1% (95% CI range, 0.6%-1.6%), 1.5% (95% CI range, 0.9%-2.1%), 2.1% (95% CI range, 1.2%-3.1%), and 5% (95% CI range, 1.9%-9.6%), respectively. There was no significant association of dislocation with the surgical approach or with the primary operative diagnosis. More than (1/2) of the dislocations occurred within 6 months postoperative. Late dislocations occurred most commonly in patients with Bateman prostheses and osteonecrosis and were associated with inner bearing dissociation. Closed reduction was successful in preventing additional surgery in only 30% of patients. The surgeon must be aware that closed reduction may be unsuccessful, and open reduction with replacement of components may be necessary. Level of Evidence: Therapeutic study, Level IV (case series). See the Guidelines for Authors for a complete description of levels of evidence.Clinical Orthopaedics and Related Research 02/2006; 442:230-8. · 2.88 Impact Factor
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ABSTRACT: While bipolar proximal femoral replacement prostheses (PFRP) have become a common treatment for tumors of the proximal femur, long-term results are not specified in the literature. The objective was to determine the complication and revision rates of bipolar PFRP and compare them to historical controls of bipolar hemiarthroplasties for nontumor indications. Information was retrospectively collected on 62 patients who received bipolar PFRP with cemented diaphyseal stems for primary or metastatic disease of the proximal femur from 1981 to 2003. Mean followup was 5 years. Twelve of 62 (19%) bipolar PFRPs underwent revision. Aseptic loosening was the most common complication with six (10%) undergoing revision. None were converted to THA due to acetabular erosion. Three patients (5%) had problems with dislocation and three (5%) had deep infections. Mean MSTS functional rating was 71% of normal function. The limb salvage rate was 98% and the 5-year event-free prosthetic survival was 79%. Bipolar PFRPs were found to have higher revision, dislocation, and deep infection rates compared to bipolar hemiarthroplasty for nontumor indications, but a lower rate of conversion to THA due to acetabular erosion. Bipolar PFRPs have good long-term durability with some complications, but are able to preserve the limb and provide good function for patients.Clinical Orthopaedics and Related Research 07/2007; 459:66-75. DOI:10.1097/BLO.0b013e31804f5474 · 2.88 Impact Factor